Imperial College London
Professor Robert Wilkinson

ProfessorRobertWilkinson

Faculty of Medicine, Department of Infectious Disease

Professor in Infectious Diseases
 
 
 
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Contact

 

r.j.wilkinson Website

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Schutz:2019:10.1371/journal.pmed.1002840,
author = {Schutz, C and Barr, D and Andrade, BB and Shey, M and Ward, A and Janssen, S and Burton, R and Wilkinson, KA and Sossen, B and Fukutani, KF and Nicol, MP and Maartens, G and Wilkinson, RJ and Meintjes, G},
doi = {10.1371/journal.pmed.1002840},
journal = {PLoS Medicine},
title = {Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: a prospective cohort study},
url = {http://dx.doi.org/10.1371/journal.pmed.1002840},
volume = {16},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: In high burden settings case fatality rates are reported to be between 11% and 32% in hospitalized patients with HIV-associated tuberculosis, yet the underlying causes of mortality remain poorly characterized. Understanding causes of mortality could inform development of novel management strategies to improve survival. We aimed to assess clinical and microbiologic determinants of mortality and to characterize the pathophysiological processes underlying death by evaluating host soluble inflammatory mediators and determined the relationship between these mediators and death as well as biomarkers of disseminated tuberculosis. Methods and Findings: Adult HIV-positive patients hospitalized with a new diagnosis of HIV-associated tuberculosis were enrolled in Cape Town between 2014-2016. Detailed tuberculosis diagnostic testing was performed. Biomarkers of tuberculosis dissemination and host soluble inflammatory mediators at baseline were assessed. Of 682 enrolled participants, 576 with tuberculosis (487/576, 84.5% microbiologically confirmed) were included in analyses. The median age was 37 years (IQR=31-43), 51.2% were female and the patients had advanced HIV with median CD4 count =58 cells/l (IQR= 21-120) and median HIV viral load=5.1 log10 copies/mL (IQR=3.3-5.7).Antituberculosis therapy was initiated in 566/576 (98.3%) and 487/576 (84.5%) started therapy within 48 hours of enrolment. Twelve-week mortality was 124/576 (21.5%) with 46/124 (37.1%) deaths occurring within 7 days of enrolment. Clinical and microbiologic determinants of mortality included disseminated tuberculosis (positive urine lipoarabinomannan, urine Xpert MTB/RIF or tuberculosis blood culture in 79.6% of deaths vs 60.7% of survivors, p=0.001), sepsis syndrome (high lactate in 50.8% of deaths vs 28.9% of survivors, p<0.001) and rifampicin resistant tuberculosis (16.9% of deaths vs 7.2% of survivors, p=0.002). Using non-supervised two-way hierarchical cluster and principal components analy
AU  - Schutz,C
AU  - Barr,D
AU  - Andrade,BB
AU  - Shey,M
AU  - Ward,A
AU  - Janssen,S
AU  - Burton,R
AU  - Wilkinson,KA
AU  - Sossen,B
AU  - Fukutani,KF
AU  - Nicol,MP
AU  - Maartens,G
AU  - Wilkinson,RJ
AU  - Meintjes,G
DO  - 10.1371/journal.pmed.1002840
PY  - 2019///
SN  - 1549-1277
TI  - Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: a prospective cohort study
T2  - PLoS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1002840
UR  - http://hdl.handle.net/10044/1/70725
VL  - 16
ER  -
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